1. VERMONT EMS EBOLA VIRUS DISEASE EDUCATION Patsy Kelso PhD, Vermont Department of Health State Epidemiologist and Vermont EMS

2. 2014 Ebola Outbreak Vermont Department of Health - EMS

3. The Outbreak  Reports as of October 24:  10,141 cases  4,922 deaths  This is the largest Ebola epidemic in history  CDC’s response is the largest international outbreak response in CDC’s history  On August 8, the World Health Organization (WHO) declared the current Ebola outbreak a Public Health Emergency of International Concern (PHEIC)  The PHEIC declaration underscored the need for a coordinated international response to contain the spread of Ebola Vermont Department of Health - EMS

4. Future Estimates of Ebola Cases in Liberia and Sierra Leone  In September 23 edition of MMWR,* CDC estimated the future number of Ebola cases if current trends continue in Liberia and Sierra Leone:  Without additional interventions or changes in community behavior, CDC indicated by January 20, 2015 there will be approximately 555,000 Ebola cases in Liberia and Sierra Leone, or 1.4 million if correction for underreporting are made.  Cases in Liberia are currently doubling every 15-20 days, and those in Sierra Leone and Guinea are doubling every 30-40 days. * The MMWR article: Estimating the Future Number of Cases in the Ebola Epidemic – Liberia and Sierra Leone, 2014- 2015It is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm, and a Q&A on the report is available at http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa-mmwr-estimating-future-cases.htmlhttp://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htmhttp://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa-mmwr-estimating-future-cases.html Vermont Department of Health - EMS

5. Outbreak Challenges in West Africa  Overburdened public health and healthcare systems  Unpaid healthcare workers  Insufficient treatment centers, beds, medical supplies, and personal protective equipment (PPE) Vermont Department of Health - EMS

6. Background on Ebola Vermont Department of Health - EMS

7. Ebola is a rare and deadly disease  First discovered in 1976 near the Ebola River in the Democratic Republic of the Congo  Outbreaks occur sporadically in Africa  Family of zoonotic RNA viruses  Historically, death rates from Ebola range from 50%-90% Vermont Department of Health - EMS

8. Transmission  Ebola virus is spread through direct contact (through broken skin or mucous membranes) with:  A sick person’s blood or body fluids, including urine, saliva, sweat, feces, vomit, and semen  Contaminated objects (like needles and syringes)  Infected animals (by contact with their blood, fluids, or infected meat)  Ebola virus has been detected in breast milk, but is not know if the virus can be transmitted through breastfeeding  Not transmitted by mosquitos or other insects Vermont Department of Health - EMS

9. Symptoms  Signs of Ebola include fever (greater than 38.0 o C or 100.4 0 F) (87%) and symptoms such as:  Fatigue (76%)  Vomiting (68%)  Diarrhea (66%)  Loss of appetite (65%)  Severe headache  Muscle pain  Abdominal pain  Unexplained hemmorrhage  The incubation period is 2 to 21 days (average 8-10 days)  A person with Ebola is not contagious until symptomatic Vermont Department of Health - EMS

10. Testing & Treatment  Virus is generally detectable in blood by real-time RT- PCR between 3-10 days post-onset of symptoms, but has been detected for several months in certain secretions (e.g., semen)  No FDA-approved vaccine or antiviral drug is available  Symptoms are treated as they appear. Basic interventions, when used early, can significantly improve the chances of survival.  Providing IV fluids and balancing electrolytes  Maintaining oxygen status and blood pressure  Treating other infections if they occur Vermont Department of Health - EMS

11. Patient Recovery  Recovery from Ebola depends on good supportive care and the patient’s immune response  People who recover from Ebola infection develop antibodies that last for at least 10 years, and possibly longer  It isn’t know if people who recover are immune for life or if they can become infected with a different species of Ebola  Some people who have recovered from Ebola have developed long-term complications (joint and muscle pain, and vision problems) Vermont Department of Health - EMS

12. CDC & EMS  http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergency-medical-services-systems- 911-public-safety-answering-points-management-patients-known-suspected-united-states.html Vermont Department of Health - EMS Vermont EMS is following the CDC’s guidance – please read!

13. Vermont EMS Ebola Virus Disease Protocol

15. CDC & EMS PPE  http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html Vermont Department of Health - EMS Vermont EMS has developed a check-list following this guidance!

16. Vermont EMS PPE Donning & Doffing Checklist  Printable version is attached to this presentation as a document and is also viewable.  Please print as many color copies as necessary. Vermont Department of Health - EMS

17. Alternative Vermont EMS PPE Donning & Doffing Checklist  Due to limitation in available PPE, the following checklist still adheres to available guidance  Printable version is attached to this presentation as a document and is also viewable.  Please print as many color copies as necessary. Vermont Department of Health - EMS

18. Next Steps  Watch the following video (approximately 21 minutes) on donning and doffing of PPE  NOTE: Please be cognizant of the poor foot hygiene at the end of the video (stepping in clean shoes in areas where booties were worn)  Review the Vermont EMS Ebola Virus Disease Protocol  Review the Vermont EMS PPE Donning & Doffing Checklist  Train with your service! (Train the trainer for Donning & Doffing coming soon) Vermont Department of Health - EMS

19. Next Steps  Any questions should be addressed to: VTEMS@state.vt.us VTEMS@state.vt.us  FAQs are being developed  This training will be updated as needed Vermont Department of Health - EMS